Δερματολογια – Πλαστικη Χειρουργικη
Melanoma
Skin Melanoma
Symptoms and Melanoma Treatment
Today, melanoma is the most aggressive form of skin cancer and although it is the least common type of skin cancer, it is responsible for 80% of skin cancer deaths. It is an extremely aggressive type of cancer which metastases to lymph nodes and distant organs, thus making early diagnosis and treatment vital.
| Treatment Time | 1 hour |
| Duration of Result | Permanent |
| Pain Level | Absolutely Tolerable |
| Anaesthesia | Local Anaesthesia |
| Treatment Cost | From 500€ |
| Result is Visible | Immediately after the treatment |
| Recovery Time | Within 1 week |
Before and After Photos of Melanoma
It is the 2nd most common cancer in young people aged 15-35
What is Melanoma?
Melanoma is a malignant skin tumour that originates from the melanocytes of the epidermis, hence its name. Melanocytes are responsible for the colour of our skin and the formation of moles. Melanoma, unlike other forms of skin cancer that usually affects older people, often occurs in young people and is the second most common cancer in people aged 15-35. Melanoma mainly affects the white race and is less common in black and yellow. The average age of diagnosis is estimated at 55 years, while both sexes are affected equally.
Clinically, melanoma usually presents with a change in size, shape and colour of an already existing mole . However, it can also appear de novo as a new mole, which is black, dark in colour and generally has an "abnormal appearance". Symptoms that may accompany it are itching, bleeding and crusting.
The most common places of appearance are mainly the back, arms, legs and less commonly the face, as well as the genitals. In men it appears mainly on the trunk, while in women on the lower limbs.
Types of Melanoma
There are 4 types of Melanoma
The first 3 types develop over time, while the 4th develops rapidly and has a poor prognosis.
Type 1:
Superficial Spreading Melanoma -is the most common type of melanoma almost 70% of all melanomas, occurs mainly in young people aged 20-40 years. If not diagnosed and treated it develops into nodular melanoma.
Type 2:
Melanoma on a Malignant Solar Lentigo (Lentigo Maligna) - occurs mainly in photo exposed areas that have suffered chronic sun damage, such as the face and neck, in older people usually over 60 years of age. Malignant Lentigo looks like a large, irregularly shaped pigmented spot.
Type 3:
Melanoma of the Extremities (soles, palms, nails) - It occurs more often in dark-skinned phototypes and has a fast progression.
Type 4:
Nodular Melanoma (the most aggressive form) - accounts for 10-15% of cases and is usually at an advanced stage when diagnosed. It appears as a lump on the skin (hence the name nodule) and is usually blue or black in colour, but it can also be pink to red in colour. This type also includes amelanotic melanoma that appears as a nodule in the colour of the skin and because of this atypical appearance, its diagnosis is delayed.
What causes Melanoma
Melanoma Risk Factors
Who is at greater risk of developing melanoma? . People belonging to the high-risk group. If your answer is positive to most of the questions below, then you should contact a Dermatologist, in order to have Dermatoscopy and Mole Mapping.
- Do you burn easily in the sun, as you are photosensitive and you have fair skin?
- Do you have a large number of moles (more than 50 moles)?
- Do you have several congenital moles?
- Do you have many asymmetric moles (more than 10 moles) on your body?
- Is there a history of multiple and severe burns during childhood and adolescence?
- Is there a history of skin cancer in your family?
- Have you already been diagnosed with skin cancer?
- Are you exposed to strong UV solar radiation at regular intervals?
Melanoma Diagnosis
The rapid diagnosis of melanoma literally saves lives and for this reason it is necessary for all of us to be well informed about the importance of self-examination of our skin, with the ABCDE rule.
The ABCDE rule
The "ABCDE" rule, is based on the following characteristics:
Α (Asymmetry)
The shape of one half of the mole does not match the other half of the mole
Β (Border)
The borders are indistinct and uneven rather than smooth
C (Colour)
There is unevenness in colour, with many colours together
D (Diameter)
The diameter is usually greater than 6 millimetres (mm) or the mole has increased in size in a relatively short period of time
E (Evolution)
The mole is evolving and changes in size, shape, colour or appearance
Diagnosis of Melanoma by Dermatoscopy
If you detect any of the above changes in a mole, talk to a qualified Dermatologist immediately.
The correct diagnosis is made by skin examination from a Dermatologist and checking of the suspected lesion by Dermoscopy.
In case the lesion is very typical and characteristic, the Dermatologist makes a clinical diagnosis of Melanoma and the surgical removal of surgical removal of the entire suspected lesion lesion and not of a part of it (as a biopsy) (SOS in pigmented lesions with suspicion of melanoma it is forbidden to biopsy a part of the lesion only, as the whole lesion should be removed), in order to make an accurate histological diagnosis of the melanoma and especially its degree of infiltration (Breslow Thickness) and its stage (Stage 1-5).
Surgical Removal of Suspected Lesion
In case the suspected lesion is not typical and is not characteristic during Dermoscopy, in order for the Dermatologist to safely diagnose it as Melanoma, surgical removal of the entire suspected lesion should again be performed (SOS not just a part of it with biopsy) to make a correct histological diagnosis.
There are cases of melanomas with serious consequences for these patients, in which a correct approach was not taken from the beginning by qualified Dermatologists or even better Dermatologic Surgeons and in which only a part of the pigmented lesion was biopsied. In these cases the possibility of a correct histological classification of the Melanoma was lost (based on the degree of infiltration - Breslow Thickness), which is necessary for the correct subsequent treatment of melanoma. That’s why it is extremely important which Doctor you trust from the beginning. The best Doctor for the correct diagnosis of skin cancers is either a certified MOHS Surgeon, or a Dermatologic Surgeon with extensive experience in skin cancer surgery.
Do NOT let them BURN it!
The surgical biopsy of the entire pigmented lesion is the appropriate method of diagnosing melanoma and under no circumstances you should allow someone to treat pigmented lesions with other, NON-surgical methods (eg diathermy, cauterization, cryotherapy with liquid nitrogen, laser removal , scraping, etc.).
Unfortunately, many patients with suspicious lesions, who were not well informed from the beginning, are incorrectly treated by General Practitioners or Doctors of other specialties. Usually Doctors who are not Dermatologic Surgeons, as they do not know how to properly diagnose and safely operate, try to treat these lesions with non-surgical methods, instead of referring these patients to Dermatologic Surgeons. Thus, a correct diagnosis is not made in time, which results in the cancer remaining in the skin and penetrating deeply into the area, in an even worse and more aggressive form.
Stages of Melanoma
According to Clark Classification, melanomas are divided histologically into five stages of infiltration, depending on the depth of the skin to which the melanoma has spread. These stages are as follows:
Stage 1: melanoma is located in the basement membrane of the epidermis, at the point where the epidermis meets the dermis.
Stage 2:the melanoma has spread to the papillary layer of the dermis.
Stage 3: extension of the melanoma to the border between the papillary and reticular layers of the dermis.
Stage 4: infiltration of the reticular layer.
Stage 5 : infiltration of subcutaneous tissues, as well as adipose tissue.
The stage of melanoma affects the chances of cure and survival.Early forms of melanoma are stages 0 and 1.
In stage 0, the cancer is non-invasive and has not progressed beyond the epidermis.
In stage 1, the cancer has invaded into the dermis, but the tumour is small and there are no signs that indicate a high risk of metastasis to nearby lymph nodes or internal organs. In the early stages, such as stage 0 and 1, the correct surgical removal is often sufficient for cure.
In stages 2 and 3, the tumours are localised, usually greater than 1 millimetre in depth and there is no evidence of metastasis to adjacent tissues. They may be medium or high-risk melanomas and may require only surgical removal and regular follow ups or may require surgical removal, plus chemotherapy and immunotherapy.
In stages 4 and 5, the melanomas have metastasized to other organs of the body and the treatment method will depend on where and how many metastases there are and the expected survival.
Treatment and Management of Melanoma
Surgical Removal and Sentinel Lymph Node Biopsy
With the histological result of the initial surgical removal and the histological classification of the melanoma and having also the results of the blood tests and the CT scans (to see if there are metastases in distant organs) the staging of the disease is done.
Further surgical removal is always done to healthy margins of 1 - 3 centimetres around the already excised initial lesion and the sentinel lymph node is also removed according to the stage. If this lymph node is not affected, no further surgical removal is needed.
However, if it has been affected, removal of the lymph nodes of the area is recommended, as well as chemotherapy and radiation therapy, where necessary. Also, in some cases, immunotherapy can be done.
Radiotherapy
Radiotherapy is used in limited cases of melanoma because melanoma is not a particularly radiosensitive tumour. It is only used in cases where surgical removal is difficult or impractical in the very elderly.
Also when the lymph nodes removal is not radical or when it is not technically possible, then radiation therapy can be applied.
It is also used in local metastases to relieve symptoms as a palliative treatment, as well as in bone and brain metastases as a method of treating metastases and relieving the patient from the symptoms.
Targeted Cell Therapies
Many different mutations have been documented in melanoma. About 50% of melanoma patients have a BRAF V600 mutation, 20% of people with melanoma have NRAS mutations and NF-1 mutations are present in about 10% to 15% of melanomas.
For all these types of mutations there are now corresponding targeted molecular therapies.
Immunotherapy
In advanced melanoma, immunotherapy is also done, which is a newer form of treatment, with special therapeutic agents that target the immune system.
Ipilimumab (anti-CTLA-4 antibody) has recently been approved in the US and Europe for the treatment of metastatic melanoma as it appears to improve the overall survival of patients.
Chemotherapy
It is an adjuvant treatment that is done along with surgical removal in patients with advanced melanoma. Nowadays, a large number of chemotherapeutic agents with similar efficacy are available.
Chemotherapy leads to tumour regression and a reduction in the symptoms associated with it and increases the life expectancy of patients with advanced melanoma.
Why to choose Derm & Plastic Surgery Clinic for Melanoma Treatment?
Derm & Plastic Surgery Clinics are specialized Aesthetic Dermatology and Plastic Surgery Clinics. In our premises, diagnostic examinations are carried out only by the Dermatologists and Plastic Surgeons of the Clinics, who have extensive experience in Dermoscopy and Mole Mapping and not by unqualified Doctors, as happens in some other places.
In our Clinics we have state-of-the-art equipment and Medical Surgical Lasers, similar to those of big private hospitals in Athens and the removal of skin cancers is done only by Dr. Zografou, who is the Scientific Director of our Clinics and the only certified Mohs Surgeon in Greece.
For us, the removal of melanoma is considered a medical procedure and the necessary time and attention and diligence are given, both during the cancer’s removal and during the recovery period of our patient. Besides that, we are just as concerned as you are, about the aesthetic results of our removals and for this reason our Clinics are equipped with the medical resurfacing Laser, which is used after the removal, to smooth the skin and give an aesthetic result, so that the area will look like as if it has not been operated on.
Meet the Derm & Plastic Way of Life - We are ensuring the quality of the services provided to you and for us the removal of Melanoma is also a treatment in premium spaces, with hygienic standards and ventilation of the spaces. Because it is important in addition to good medical devices, to feel well and be treated in beautiful modern rooms and not to perform medical procedures in old and depressive spaces, with dubious hygienic conditions and controls.
Our philosophy is Luxury at Affordable Prices and what differentiates us from all the others is that here you will find medical services with the highest standards, in luxury spaces, with maximum effects and at affordable prices. All you have to do is to book your appointment at one of our two modern Clinics, where we will inform you about our medical protocols!
Derm & Plastic TV
What does Melanoma look like?
If you detect any of the changes you will see in this video in an olive, talk to a qualified Dermatologist immediately.
The correct diagnosis is made by an examination by a Dermatologist and inspection of the suspected lesion by Dermoscopy.
In case the lesion is very typical and characteristic, the Dermatologist makes a clinical diagnosis of Melanoma and the surgical removal of of the entire damage and not a part of it as a biopsy.
Myths & Truths about Melanoma
Myth: Melanoma only occurs in fair-skinned people
Truth: It's true that Melanoma is more common in fair-skinned people, yet it can affect people of all skin types, including those with darker skin. Melanoma can also develop in areas not normally exposed to the sun, such as the palms, soles of the feet and genitals.
Myth: Melanoma only occurs on pre-existing moles
Truth: While Melanoma primarily develops on pre-existing moles, it can also appear de novo as a new mole, which is black, dark in colour and generally has an "abnormal appearance". Symptoms that may accompany it are itching, bleeding and crusting. The rapid diagnosis of melanoma literally saves lives and for this it is necessary for all of us to be well informed for the self-examination of our skin, with the ABCDE rule.
Myth: The artificial tanning with Solarium is safer than tanning in the sun
Truth: Tanning beds emit harmful ultraviolet (UV) radiation that increases the risk of skin cancer, including melanoma. Solarium use is not at all safe and should be avoided, especially by young people. According to a study by the World Health Organization, people who have used Solarium at least once have a 20% higher risk of developing melanoma, compared to those who have never used it. If the first use of the Solarium is under the age of 35, the risk increases to 60%.
Myth: Only the elderly can develop Melanoma
Truth: While Melanoma is more common in older people, it can occur in people of all ages, including young adults and even children. It is the 2nd most common cancer in young people aged 15-35.
Frequent Questions about Melanoma
- People with numerous moles (over 50)
- People with a family or personal history of Skin Cancer or Melanoma
- People with fair skin phototype (phototype I & II) and many moles
- People with a history of sunburns, especially in childhood or adolescence
- People with giant congenital mole
- People with dysplastic mole syndrome – presence of a large number of atypical - dysplastic moles on the body
There are many ways you can reduce your risk of Skin Cancer:
- Limit your exposure to solar UV radiation , especially between 1:00 p.m. and 5:00 p.m.
- Use broad-spectrum sunscreen when exposed to the sun. The broad spectrum will help protect against UVA and UVB rays
- Use at least SPF 30 in your sunscreen and apply it often
- Avoid Solarium use (using Solarium for the first time under the age of 35 increases the risk of melanoma by almost 60%)
- Do a monthly skin self-examination, based on the ABCDE rule
The most common places for Melanomas are mainly the back, arms and legs and less commonly the face, and the genitals. In men it appears mainly on the trunk, while in women on the lower limbs. In addition to the skin, melanoma sometimes occurs in the mucous membranes (mouth, genitals) and the eye.
Yes, it is possible for this to happen. A mole that is exposed to the sun and changes over time can develop into Melanoma. Therefore it can turn from a simple nevus into a dysplastic one. The dysplastic nevus is essentially a stage before Melanoma, which is why it needs special attention and immediate surgical removal.
Surgical removal of Melanoma is considered a painless procedure. The use of local anaesthesia ensures that patients do not feel discomfort or pain during the procedure. The Doctor will administer local anaesthetic to numb the area, ensuring that you remain comfortable throughout the procedure.
After removal, it is common for patients to experience minimal discomfort and tenderness at the surgical site, however, they are able to return to their daily activities immediately. This minor discomfort can typically be treated with simple painkillers such as paracetamol and usually subsides within a day.
In the early stages of melanoma, surgical removal provides a complete cure. However, in the advanced stages, unfortunately, there is no possibility of a complete cure. For this reason it is particularly important that there should not be the slightest delay in case of suspicion of melanoma.
The most frequent metastases that melanoma gives are in the bones, liver, lung and brain. However, it can metastasize to any other part of the body.
Life expectancy depends on the stage of the disease and the type of melanoma. When diagnosed at an early stage the five-year life expectancy is 98%, if lymph nodes are affected it is 64% and if there are metastases in distant organs it is 23%.
As we mentioned above, melanoma removals are performed in Derm & Plastic Surgery Clinics with local anaesthesia and Minimally Invasive Surgery methods (a field in which Dr. Zografou holds a Master's degree), so you can return to your daily activities immediately.
- Body area: Some areas of the body are known to heal better and some others not, for example the chest, décolleté and shoulders are more likely to develop keloids during surgical removals.
- Technical and Surgical Skills of the Doctor: The right choice of Doctor, who should be a Dermatologic Surgeon or a Plastic Surgeon with excellent knowledge of anatomy and many years of surgical experience, plays a major role in the outcome of the removal and the final aesthetic result. Do not be convinced by very low prices and trust your health in the hands of non-specialist Doctors, as then you will have to pay double and triple to qualified Doctors to do corrections for you. In Derm & Plastic Surgery Clinics, the removal of skin cancers is done only by the Scientific Director Dr Zografou, who is the only certified Mohs Surgeon in Greece and holds a Master's Degree in Minimally Invasive Surgery. She has many years of specialization and experience in dysplastic moles and skin cancer and hundreds of patients in Greece and abroad
- Healing Ability: Each person's healing abilities also play a big role. Some people heal very well and quickly and others heal slowly with the creation of atrophic or hypertrophic scars. Therefore you should wonder.. Are you a Good Healer or a Poor Healer?
- Adherence to post-operative instructions: Post-operative instructions and compliance by people who have recently undergone surgical removal are also important. Often due to improper adherence to instructions and application of pressure to the surgical area (e.g. vigorous exercise with weight lifting, when the area is still healing), gradual opening of a wound and distension of the surgical scar occurs. Therefore while the area initially heals properly, some time after the stitches are removed, the fine line that was initially there begins to widen and grow and look ugly. That’s why it is important to follow the Doctors' instructions carefully.
In addition to their initial diagnosis and treatment, another reason why people from all over Greece visit our Clinics is their desire to correct post-surgical scars, as in Derm & Plastic Surgery Clinics we have state-of-the-art resurfacing Lasers, which after some sessions eliminate old scars. We are always concerned for the aesthetic results of our treatments and for this reason in our Clinics, post surgical protocols are applied to smooth the skin and give an even aesthetic result, so that the area looks like it had no operation on it.
If you have a question about this treatment that is not answered in the text above, please send your question to the Doctor. Don't send questions about treatment costs and prices, as these are only formulated after the medical consultation, either in person at our Clinics or by Online Consultation.
Book an appointment and come to one of our Clinics or if you don't have time or live far away, request a video call consultation first and then come directly for your treatment.
